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Lately it seems that just about everyone I know in Free and Open Source Software in medicine has more paid work and opportunities with medical FOSS than ever before. Is this just my perception or part of a rising medical IT tide that is floating all boats?

A Health Affairs research article entitled ‘The Value of Electronic Health Records In Solo or Small Group Practices’ presents some much needed economic data on EHR deployments in small offices. Of interest to Free and Open Source Software users is that according to this study, one-third of the cost was due to proprietary software: ‘…Software, training, and installation costs averaged $22,038 per FTE provider. Where data permitted separate estimates, we calculated that software alone accounted for about one-third of overall costs. Software costs depended on such factors as interfaces, other EHR-related software, and the negotiating savvy of the EHR champion; one practice acquired sharply discounted software from another practice. Installation and training costs ranged from virtually none (where there were technically savvy EHR champions) to more than $14,000 per FTE provider. Hardware costs per provider averaged almost $13,000 per FTE provider, ranging from under $7,500 for four practices that had new equipment pre-EHR or acquired used equipment to more than $23,000 for two practices that had little usable pre-EHR equipment, including networking. Revenue losses from reduced visits during training and implementation averaged $7,473 per FTE provider, ranging fromnone (in two practices) to $20,000 per FTE provider in one practice. Losses depended in part on the extent to which providers worked longer hours initially instead of reducing patient visits…’

iHealthBeat has an article detailing the results of a RAND corp. study that says a EMR network will cost over $100 billion over 15 years: ‘…Implementation of a nationwide electronic health records network would take about 15 years and cost hospitals about $98 billion and physicians about $17 billion, according to a study by Richard Hillestad and colleagues at RAND, the AP/Las Vegas Sun reports (Neergaard, AP/Las Vegas Sun, 9/14).

It looks like the banking industry is getting into the act, according to this article a “medical banking platform” will be created ‘…that will use existing open source/open standards. Where there are gaps in standards, MBProject is sponsoring the creation of a new type of open source standards/components called “mbXML”…’ Another article states: ‘… “We don’t want to displace any effort,” executive director John Casillas says. “We want to enable it. We think the bank is uniquely positioned to provide the connective tissue and they can do it more than any other industry.”…’ My un-schooled, pedestrian opinion is that this seems like PayPal for healthcare. Thanks to Ed Dodds for these links.

Health IT News has a short piece on the passage of a bill in the House of Representatives authorizing more spending on Health IT: ‘…The bill (H.R. 3010) includes $58.1 million for �grants, contracts and cooperative agreements for the development and advancement of an interoperable national health information technology infrastructure.� In addition, it makes $16.9 million available under the Public Health Service Act �to carry out health information technology network development.� The White House requested $75 million for the Office of the National Coordinator for Health Information Technology in fiscal year 2006 budget…’ There are now major federal RFP dollars being floated around so if you aren’t on a RFP team, find one and join up fast.

Health Data Management has an article about a Bill that calls for $4 billion in health care IT spending over 5 years: ‘Bipartisan legislation introduced in the Senate on June 13 would authorize $4.05 billion in grants to providers over five years to adopt interoperable information technology.

Under the legislation, providers could apply for grants not to exceed $1 million for a hospital; $200,000 for a skilled nursing facility; $150,000 for a federally qualified health center; $75,000 for a community mental health center; $15,000 per physician for a group practice; and $15,000 for an individual physician…’

AHRQ has announced a program seeking 100 grants “…As part of a larger initiative to support investments in information technology in the nation’s health care delivery system, the Agency for Healthcare Research and Quality today announced that it is seeking applications for approximately 100 grants to plan, implement, and demonstrate the value of health information technology to improve patient safety and quality of care. These grants will be part of a $50 million portfolio of grants, contracts, and other activities to demonstrate the role of health information technology to improve patient safety and the quality of care…” Could this benefit Free and Open Source Software in Medicine? Read on for full text of the announcement.

As part of a larger initiative to support investments in information technology in the nation’s health care delivery system, the Agency for Healthcare Research and Quality today announced that it is seeking applications for approximately 100 grants to plan, implement, and demonstrate the value of health information technology to improve patient safety and quality of care. These grants will be part of a $50 million portfolio of grants, contracts, and other activities to demonstrate the role of health information technology to improve patient safety and the quality of care.

“These grants will give health care providers the resources they need to implement real-world health care information technology solutions to improve the quality and safety of health care,” said AHRQ Director Carolyn M. Clancy, M.D. “This is an important addition to AHRQ’s existing $165 million investment in patient safety. I am particularly pleased that a large proportion of these grants will be used to fund projects in rural and small communities throughout America, where the opportunity is so great.”

The $41 million grant program, “Transforming Healthcare Through Information Technology,” includes grants for planning and implementation of health information technology in communities as well as grants to examine its value. The awards, supporting over 100 new research and demonstration projects, will comprise the core of AHRQ’s Health Information Technology portfolio. Applications will be accepted from public and private non-profit organizations, including universities, clinics, and hospitals; for-profit organizations (for implementation grants only); faith-based organizations; and state and local government agencies throughout the United States.

The Agency expects to award up to $24 million to fund as many as 48 new implementation grants under the first Request for Applications, with up to $14 million going to small and rural hospitals and communities. The RFA emphasizes the importance of community partnerships. AHRQ will provide up to 50 percent of the total costs in matching funds, not to exceed $500,000 per year, for each project. Letters of intent are due February 22, 2004, and applications are due April 22, 2004. For further information, go to the NIH Guide at http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-04-011.html.

As much as $7 million is expected to be awarded under the second RFA to fund up to 35 new planning grants to provide communities and organizations with the resources needed to develop their health information technology infrastructure and compete for future implementation grants. At least $5 million is expected to be used to support applicants from rural and small communities. Projects can last up to 1 year, and applicants may request budgets of up to $200,000 in total costs. Letters of intent are due March 22, 2004, and applications are due April 22, 2004. For further information, go to the NIH Guide at http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-04-010.html.

Demonstrating the value derived from the adoption, diffusion, and use of health information technology will be the focus of the third RFA, awarding approximately $10 million to up to 20 new grantees. The objective of these projects will be to provide health care facilities and providers with the information they need to make informed clinical and purchasing decisions about using health information technology. Applicants may request budgets of up to $500,000 per year in total costs. Letters of intent are due March 22, 2004, and applications are due April 22, 2004. For further information, go to the NIH Guide at http://grants.nih.gov/grants/guide/rfa-files/RFA-HS-04-012.html.

The remainder of the $50 million portfolio will be spent on other activities, including the creation of a Health Information Technology Resource Center to aid grantees by providing technical assistance, provide a focus for collaboration, serve as a repository for best practices, and disseminate needed tools to help providers explore the adoption and use of health information technology to improve patient safety and quality of care.

AHRQ also will award the Indian Health Service $2 million in fiscal year 2004 toward the enhancement of the IHS electronic health record. This will permit individual facilities flexibility in how they configure their electronic health record system. The creation of an IHS electronic health record is consistent with tribal leaders’ identification of the need for a user-friendly data system that can provide community specific health care data and track the health status of the patient population. This need has been identified as one of seven top tribal priorities during HHS tribal consultation.

Here is an article in the Bostom Globe about Athenahealth, a medical billing firm that gives a view of the quagmire that is medical billing: ‘…At the heart of the business is a giant, ever-changing database. The Waltham folks collect and decipher the multitude of billing codes and idiosyncratic rules that insurance companies use to pay claims, then track each claim’s path, until the checks are in the mail. Not only are there literally thousands of different codes used to identify medical procedures, and a different number assigned to every doctor by every health plan, but each insurer piles its own peculiarities onto this numeric heap…’

The Wall Street Journal (paid subscription required) is reporting that HMO Kaiser Permanente is going to be spending $1.8 billion to ‘put the medical records of its 8.4 million patients online…’ with proprietary vendor Epic Systems. $1.8 billion? Whew! Perhaps they haven’t heard of Free/Open Source software like VistA. Per the article, Kaiser has 8.4 million patients. That comes out to $214 per patient which seems rather pricey. Especially in view of what they don’t get: portability outside of Kaiser, standardization of interface outside of Kaiser, 3rd party verification of confidentiality or clinical process, any ownership at all of source code and single point of failure by relying on one vendor. I suppose it is progress over a paper record if they can pull it off.

Updated at 1700: Almost missed the real story further down that the American Academy of Family Physician’s is considering open source. American Medical News has an article which may sound all too familiar. It is one Doctor’s saga with 3 different electronic medical record software, concluding that: “The most expensive was the worst and by far the cheapest was the best,” but it still didn’t work for her. It is a good read, if nothing else to note the money and time wasted, the arrogance of a closed-source vendor and the passing mentions of shoddy OS software: ‘”The problem with Dr. Orchard is that she was very computer illiterate,” said Richard Low, MD, Infor-Med’s CEO. Thousands of doctors are “highly satisfied” with his software because it helps them save time and work more efficiently; but to reap those benefits they had to learn to use the Praxis EMR software. “She refused to learn,” Dr. Low said…’ Thanks to Gary Kantor for this link.